Regulation for Prevention of Influenza Transmission by Healthcare and Residential

Facility and Agency Personnel

Emily Lutterloh, MD, MPHDirector, Bureau of Healthcare Associated Infections, NYSDOH

andErnest J. Clement, RN, MSN, CIC

Epidemiologist/Infection Preventionist,Bureau of Healthcare Associated Infections, NYSDOH

Outline

Regulation overview Legal citations and effective date Applicability and definitions Requirements

Reporting Frequently Asked Questions Contact Information

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Legal Citations & Effective Date

Statutory Authority: Public Health Law (PHL) Sections 225, 2800, 2803, 3612, and 4010

Regulatory provisions located in a new Section 2.59 of the State Sanitary Code

Additional provisions reference Section 2.59 10 NYCRR Sections 405.3, 415.19, 751.6, 763.13,

766.11, and 793.5 Became effective July 31, 2013

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Applicability – Which Entities

Hospitals, general hospitals, nursing homes, diagnostic and treatment centers (all “Article 28 facilities”)

Certified home health agencies, long term home health care programs, AIDS home care programs, licensed home care service agencies, limited license home care service agencies (all “Article 36 agencies”)

Hospices (as defined in Article 40 of the PHL)

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Applicability – Who

All personnel in healthcare and residential facilities and agencies who engage in activities such that if they were infected with influenza, they could potentially expose patients or residents to the disease

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Applicability – Who

All persons employed or affiliated with a covered healthcare or residential facility or agency, paid or unpaid. Includes but is not limited to: Employees Members of the medical and nursing staff Contract staff Students Volunteers

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Applicability – Who

Does not apply to visitors to facilities or family members of patients/residents Visitors typically only come in contact with

specific patients/residents, whereas staff come in contact with many patients/residents

Facilities are encouraged to establish policies for visitor restrictions to limit influenza transmission

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Applicability – Where and When

Areas where patients or residentsmay be present

Only during the period of time in which influenza is prevalent as determined by the Commissioner.

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Requirements

Healthcare and residential facilities and agencies must: Determine and document which persons qualify as

“personnel” under the regulation. Document the influenza vaccination status of all

personnel for the current influenza season. Upon Department request, report the number and

percentage of personnel that have been vaccinated against influenza for the current season.

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Requirements

Healthcare and residential facilities and agencies must: Ensure all personnel not vaccinated against

influenza for the current influenza season wear a surgical or procedure mask while in areas where patients or residents may be present.

Identify those areas where patients or residents may be present and, accordingly, unvaccinated persons must wear a mask.

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Reporting

All covered entities are required to document the number and percentage of personnel vaccinated against influenza for the current season and report these data to the Department upon request

The Healthcare Personnel Influenza Vaccination Report will be the mechanism for reporting

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Reporting

Mandated electronic report Must be completed on the Health Electronic

Response Data System (HERDS) on the Health Commerce System (HCS) at https://commerce.health.state.ny.us/

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Reporting At least 2 reports this season The first report will open November 1, 2013

and be due by November 15, 2013 Please ensure that a member of your staff has an

HCS role before November 1, 2013 Further instructions, including a sample report

and FAQs, was distributed to covered entities and associations in August 2013 and is available online at www.health.ny.gov/FluMaskReg

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FAQs: What do we do about staff who refuse the vaccine?

Staff are free to refuse the vaccine for any reason or for no reason at all

Unvaccinated staff will need to wear a mask, regardless of the reason they are unvaccinated

Facilities/agencies may institute policies surrounding declination Declination forms

Sample Declination Statement from NYSDOH available at www.health.ny.gov/FluMaskReg

Education

Education is important!15

FAQs: Masks Surgical or procedure masks

May also be labeled as laser, isolation, dental, or medical procedure masks

May be secured by ties or ear loops

Face shields and N95 respirators are not required to meet the requirementsof this regulation Standard and Transmission-Based Precautions

apply as usual16

FAQs: Masks

Masks should be changed when: Leaving the room or completing care of a

patient/resident on isolation precautions Whenever it is soiled or might have become soiled Per facility protocol

Hand hygiene should always be performed after removing contaminated masks

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FAQs: Exposure

Influenza is transmitted primarily by large-particle respiratory droplets that do not remain suspendedin the air Sharing a 6-foot space with a patient (person-to-

person contact) or a surface that comes in contact with a patient (equipment-to-patient contact).

Facilities/agencies are responsible for developing medically appropriate protocols based upon the potential for personnel to expose patients or residents to influenza.

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FAQs: Exposure Areas where patient contact is expected:

Patient/resident rooms, resident dining areas,nurses’ stations, unit/floor hallways, patient transport elevators, diagnostic and treatment areas, patient homes

Areas where patient contact is not expected: Business or administrative offices Facility services (e.g. laboratory (except drawing

stations), engineering, laundry, sterile processing) Non-human research facilities

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FAQs: Exposure

Public areas within facilities Facilities are responsible for determining areas

where masks must be worn by unvaccinated personnel as outlined in the regulation

Areas where patients/residents are not “typically” found would not require mask useby unvaccinated personnel Policies should be developed to address unusual

situations when patients are unexpectedly present

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FAQs: Why do staff members have to be vaccinated or wear a mask

when residents and participants in day programs do not?

Practicalities Efficacy of vaccine higher in young/healthy

persons than in elderly persons* No exemptions in regulation

for congregate settings

21* http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a2.htm?s_cid=mm6207a2_w

FAQs: What if masks frighten residents or participants in day

programs? Ensure that all staff members who are willing

and able are vaccinated Consider what you do when masks must be

worn for other reasons Work with staff at your facilities who address

psychosocial concerns among residents/participants Educate to the extent possible, reassure

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FAQs: Enforcement

It is the responsibility of each facility/agency to enforce its policies related to this regulation

Enforcement by facilities/and agencies is expected to occur much like enforcement of other infection control policies

Enforcement by DOH will also be similar to that for other policies, ex. citations, need for a plan of corrections

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FAQs: Home Care

Home care agencies are coveredunder this regulation

Home care personnel would be covered when they provide services at an assisted living facility, just as they are when they provide services at a private home

Home care agency is responsible for verifying immunization status, reporting, and enforcement

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FAQs: Influenza Season

Influenza season begins, peaks, and ends at different times in different years

Commissioner will likely designate influenza “prevalent” based on Department influenza surveillance data

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FAQs: Influenza Season

Influenza Season Dates “Widespread” # Weeks “Widespread”

2007‐2008 January 12 – April 19 15

2008‐2009(H1N1 pandemic)

January 31 – April 11June 6 – July 11

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2009‐2010 October 3 – December 12 11

2010‐2011 December 25 – April 9 16

2011‐2012 March 10 – May 19 11

2012‐2013 November 24 – April 20 22

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FAQs: Influenza Season

The Commissioner's decision that influenza is prevalent may be announced by some or all of the methods below HCS Informational Message Dear Administrator Letter Message on the public website Press release

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FAQs: Vaccination Documentation Documentation must have been generated by

the individual administering the vaccine and must include: Date of vaccination Name of individual who ordered or administered

the vaccine Business address of individual who ordered or

administered the vaccine* Self-attestation of vaccination is not acceptable

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* For initial implementation of this regulation, if the documentation does not include the business address, the immunized individual may provide the business address.

FAQs: DOH Surveyors

Not covered under regulation NYSDOH policy with similar requirements is

under development Facilities/agencies are not responsible for

verifying vaccination status of DOH staff

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Contact Information

NYSDOH influenza regulation questionsEmail: FluMaskReg@health.ny.govWeb: http://www.health.ny.gov/FluMaskReg

Health Commerce System account questionsEmail: hinhpn@health.state.ny.usPhone: 866-529-1890 Option 1 (8am-4:45pm EST, excluding weekends/holidays)

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